It’s all comes down to timing. The IT leaders at EMH Healthcare had been trying to propel EHRs to the top of the priority list when the Meaningful Use hammer came down, forcing the organization to revive a project that had been pushed to the back burner. EMH had fallen right into “the sweet spot,” according to CIO Charlotte Wray, and began its journey from a paper-based organization to earning Stage 6 recognition. In this interview, Wray talks about what it takes to lead a clinical transformation, her strategy in working with independent docs, how community hospitals can benefit from using consultants, and what EMH is doing to increase patient engagement. She also discusses why it’s critical to market IT achievements, her focus on optimization, and how she has been able to leverage her experience as a clinician.
- About EMH Healthcare
- Siemens Soarian in the hospital, Allscripts Enterprise in ambulatory
- MU pushing EHR plans to the forefront — “We fell into the sweet spot.”
- From a mostly-paper environment to Stage 6
- Leading a clinical transformation — “Include key stakeholders in the decision-making process.”
- Aligning with the CNO
- Physician pushback after go-live
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We really just fell into what I would call the sweet spot. We were down the road to deploy a full EHR across the enterprise. When the MU guidelines were published, we took a pause, looked at our milestones and our timeline, and we realigned some of those activities to be on a parallel pathway with the MU guidelines.
I think the most important thing that we did was include key stakeholders in the decision-making process, from the selection of the vendor and the solutions to the design and build decisions, where appropriate, as well as the communication strategy and the implementation plan.
It was critical to get her buy-in — not only for the decisions we were making about what we were doing and when, but how aggressively we were going to push change through that organization.
I don’t think there was resistance until they went live with the change and then a couple of weeks after, the reality hit of ‘my workflow is really changing.’ I think that’s when the human condition is such that it pushes back just a little bit, but the organization did extremely well.
I wish I would have had more interest up front. It wasn’t until they realized their cheese was moving that they very much got engaged and they had a lot of great suggestions, some of which would have been nicer to have more on the frontend of the project.
Gamble: Hi Charlotte, thanks so much for taking the time to speak with us today.
Gamble: Okay. To start off, just to give our readers and listeners a lay of the land, can you tell us a little bit about EMH Healthcare?
Wray: EMH Healthcare is a medium-sized community hospital about half an hour west of greater Cleveland, Ohio. We serve a community of about 350,000. We have three health campuses with one acute care facility and a couple of ambulatory facilities, as well as a splattering of physician offices around the region. Our acute care facility is about 387 beds, and we have been using Siemens Soarian in the acute care space and Allscripts Enterprise in the ambulatory space.
Gamble: As far as Siemens Soarian, when did you implement that? And when did the planning begin for that?
Wray: The planning for that probably began in the mid-2005 or 2006 era. We were actually on a road to purchase another solution, and toward the end of the negotiating process, that vendor was purchased by another vendor. So we took a pause and in March of 2009 we did sign a purchase agreement with Siemens to purchase the solutions for both Soarian Clinicals and Soarian Financials. We went live with our first clinical events in October of 2009.
Gamble: So obviously this was right around the time that everything for Meaningful Use started to come down. How did that impact your strategy? Did you have to realign some goals? How did that work for you?
Wray: The timing there, I think, is an example of being lucky as opposed to being good. We really just fell into what I would call the sweet spot. We were down the road to deploy a full electronic healthcare record across the enterprise. When the Meaningful Use guidelines were published, we took a pause, looked at our milestones and our timeline, and we absolutely realigned some of those activities to be on a parallel pathway with the Meaningful Use guidelines.
A good example would be computerized physician order entry. I think at the beginning, the organization and the senior leadership maybe were a little worried about the physician adoption, so they were thinking they might want to push that off toward the end. Well, with Meaningful Use, that gave us a great opportunity to push it right up into the forefront and do, I think, a very good job of engaging the docs and getting them involved in using the EMR and improving patient care in the process.
Gamble: You said that you’d started the planning a couple of years earlier, so what was your reaction when Meaningful Use really came out? What were your first thoughts about it?
Wray: My background is a little bit of a hybrid background. I’m a clinician by trade and then I migrated into IT over the course of the last 10 years or so. So for me, Meaningful Use made a lot of sense. I understood the disparities of healthcare in the country and I understood the evidence behind the goals of Meaningful Use, at least the elements surrounding patient care and trying to reduce the variability in care and improve compliance to evidence-based guidelines. So for me it was ammunition, and it was certainly another body expressing what I would think that we would want to do anyway. It certainly helps support our strategic plan for IT as it related to deploying that electronic record.
Gamble: Before you implemented Siemens, was it something where you had a few different solutions or were parts of the hospital still on paper? What was the picture before then?
Wray: I think that like a lot of facilities, we have a hybrid of some niche systems and a core system. At that time, we were on paper. The patient care on the nursing floors and in the patient care areas was 100 percent completed on paper. Exceptions to that would be in radiology, where they had a PACs system and a physician report writing system, as well as in cardiology, where they had an image archive PACS system and a report-writing solution. But everything else was on paper. It was quite a change process for us.
Gamble: Yeah, that sounds like this really is a case where you needed to do a clinical transformation. Can you talk about what it took to help lead the organization through such a big change?
Wray: Looking back, I think the most important thing that we did was include key stakeholders in the decision-making process, from the selection of the vendor and the solutions to the design and build decisions, where appropriate, as well as the communication strategy and the implementation plan, education and go-live support. We had clinicians at various levels in the organization working closely with IT professionals to put together a really good multidisciplinary team, and that’s how we made our decisions.
I was very closely aligned with our Chief Nursing Officer; that was critical. The chief nursing officer is in charge of the largest workforce of clinicians in our hospital. At that time, I think it was greater than 700 nurses, and it was critical to get her buy-in — not only for the decisions we were making about what we were doing and when, but how aggressively we were going to push change through that organization. Because she still has to be responsible for safe patient care during all of this flux.
Gamble: How was the buy-in — was it a bit of a tough sell? Did it really make a difference having those clinician leaders?
Wray: I think it made a big difference. I don’t think it was a tough sell. We did a very good job of putting together a communication strategy. We worked with marketing to develop some buzz. We put some little opportunities together for people to understand what we were doing — little snippets about what’s coming down the road. We had a little Soarian guy that we would put all over the organization. He would keep people updated and try to get people excited about the change.
I don’t think there was resistance until they went live with the change and then a couple of weeks after, the reality hit of ‘my workflow is really changing.’ I think that’s when the human condition is such that it pushes back just a little bit, but the organization did extremely well. The nurses, the doctors — I’m so proud of the work they’ve done. They have really transformed the care that they provide to their patients and really made a big difference.
Gamble: It really is a tremendous change. I would imagine that you deal with a lot of independent physicians. Are there any that are owned by EMH?
Wray: We do have about 74 employed physicians. Physicians, as you know, are very entrepreneurial in nature anyway and they’re scientists, so given the fact that even though we employ a significant number, for us, it’s less than half of our medical staff. We definitely had to be sensitive to the independent physicians — not only those practicing in multiple offices but at multiple hospitals and multiple surgery centers. We had to be very flexible with how we engaged them in the design and build decisions, as well as how we rolled out those solutions to them.
Gamble: Did you have something in place where there were regular meetings, like town hall meetings, things like that?
Wray: We had a physician advisory council, and I would say that the physician interest in that at the beginning was suboptimal. I believe that it was intriguing, the EMR, but it was away in the distance for the physicians. So the feedback that I received was, ‘Let us know when it’s really close to going live.’ And as you know, ideally you want those physicians engaged as much on the frontend as possible. So I think a lesson learned for our organization and our physicians was that we really needed to be more persistent in getting those town hall meetings up in front of the physicians. We did utilize the newsletters, email, and various medical staff meetings, but I wish I would have had more interest up front. It wasn’t until they realized their cheese was moving that they very much got engaged and they had a lot of great suggestions, some of which would have been nicer to have more on the frontend of the project. But nonetheless, it was still a very successful process.
Gamble: You mentioned Allscripts before. Are a good percentage of the independent physicians using Allscripts?
Wray: Well, 100 percent of our employee physicians are using Allscripts Enterprise and they all attested to Meaningful Use this year, so we’re very proud of them. I’ve been working with our independent physicians to support them with regional extension centers and assist them in adopting technology of their choice. We have also repackaged our Allscripts licensing and they can buy a turnkey solution from us and we will install Allscripts Enterprise in their offices for them if it’s a good fit. But they can use whatever system makes sense for them. As you know, there are a lot of specialty systems out there and sometimes the physicians like to partner with a vendor that they think is giving them a free or very economical solution. And as much as you like to try to convince them that they may want to rethink that, it’s an independent decision that they make. But a significant percentage of our docs are using Allscripts Enterprise, which is wonderful.